Remote Weight Loss Intervention Found to Be More Effective than Self-Directed Weight Loss

Remote nutritional coaching and other intervention tools can help promote successful weight loss after breast cancer compared to self-directed weight loss alone, according to a new study by BCRF researcher Dr. Vered Stearns.

Several studies demonstrate the benefits of weight loss for women and men who have been successfully treated for breast cancer (and even for those who haven’t had breast cancer). Practical methods of helping them do so are of utmost importance. Moreover, there is a pressing need for scalable weight loss interventions that can be readily integrated into clinical practice.

Dr. Stearns’ clinical trial results, published in Clinical Cancer Research, compared the POWER-remote weight loss intervention program against a self-directed approach in women with a history of breast cancer. The study sough to identify the best strategy to achieve a weight loss of at least 5 percent. Investigators also examined the effect each method had on levels of biomarkers relevant to breast cancer risk.

POWER-remote refers to a weight loss intervention program that couples telephone-based behavioral, motivational, and nutritional coaching, with web-based self-reporting tools for tracking diet, exercise, and weight. Trained coaches regularly monitored participants’ self-reported data and followed up with them over the course of the 12-month study.

The self-directed weight loss group reflected standard medical care, where participants’ oncologists encouraged them to achieve and maintain a healthy BMI. These participants also received a one-time coaching session from the POWER-remote group’s coach.

At six months, 51 percent of women in the POWER-remote group lost at least 5 percent of their baseline body weight compared to only 12 percent of women in the self-directed weight loss group. This weight loss was sustained over the 12 months of the study.

At the end of the study, patients in the POWER-remote group achieved a significant decrease in waist circumference (6.6 cm) versus an increase (by 0.3 cm) in the self-directed group. This is potentially significant, since waist circumference is associated with increased breast cancer risk in both pre- and post-menopausal women.

Weight loss, in general, correlated with significant decreases in leptin, a hormone shown to be involved in metabolism and breast cancer cell proliferation.

All patients that met the 5 percent weight loss goal showed significant decreases in triglycerides and small decreases in total cholesterol. This result is particularly relevant since high triglycerides and total cholesterol ratio are associated with increased cardiovascular risk. Cancer treatment in obese patients can further increase this risk.

Telomere length was not affected by weight loss, calling into question the association of short-term weight loss and this measure. This is potentially significant since the shortening of telomeres (specialized structures that ensure the stability of chromosomes) is associated with aging and increased cancer susceptibility.

The links between weight loss and breast cancer risk

Excess body weight is a major risk factor for breast cancer. In fact, women who are overweight or obese experience worse survival outcomes because of metabolic and molecular changes and inflammatory responses resulting from treatment.

Unfortunately for various reasons, many women gain weight after a cancer diagnosis, which can increase their risk of recurrence and death. Several studies have linked weight loss after successful breast cancer treatment to improvements in cancer outcomes. Although these studies have demonstrated the importance of weight loss, they show limitations in translating interventions into clinical practice.

This new study showed the effectiveness of POWER-remote weight loss intervention, which can potentially be scaled up to cover a large number or patients and easily be applied to a clinical setting.

Follow up studies will be performed by a member of Dr. Stearns team, Dr. Jenni Sheng, the 2019 recipient of the Evelyn Lauder Young Investigator Award.